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<br />FEDERAL GENCV MANAGEMENT AGENCY
<br />PRELIMINARY 0 AGE ASSESSMENT SITE ESTIMATE
<br />
<br />SHEET
<br />DATE
<br />
<br />OF
<br />
<br />SHEETS
<br />
<br />PART I - APPLICANT INFORMATION
<br />IJeI'T ~F ~~~AL NAME OF LOCAL CONTACT
<br />,!1J.P,eH',.;s 60/ ~,/ r//E'A
<br />PART 11- SITE INFORMATION
<br />KEY FOR DAMAGE CATEGORY (U.. opproprIG,. .tt.,..". the "cet..o,," bloc'" "....Iow)
<br />
<br />
<br />~
<br />
<br />"
<br />
<br />
<br />COUNTY
<br />
<br />.. DEBRIS REMOVAL d. WATER CONTROL FACILITIES
<br />b. PROTECTIVE MEASURES .0 PUB)..IC BUILDINGS
<br />c. ROADS AND BRIOGES fo. PUBLIC UTILITIES
<br />SITE CATE- LOCATION (U.. mu JoeatJon, odd,.... etc.,
<br />NO. GORY vA'/u~u.~ i!-",CAr'O~' "'...... A-'!UTE,eAo- Sk,":'
<br />B h-elf.t.,/A"'s 6"" l,4..Jt.rz...- se""e;e: "r.c-lr/~:S
<br />
<br />DESCRIPTION OF DAMAGE .-
<br />(#,tI,.,....,..J ",,,'" FA_It ~, "'4"'-'."$'- #f..JfT~-Sr:-"",~;a SYsrFnJ 1.I't.$PO 411.,(, T"~I'A. ~#reA4'A~(.,A.
<br />/t-c.""" It, ,,..;If--C.TS 71 I!'TN'~" 'It.r~c"T' S""ST~ F~.L.I r-it-s ciA! /~"~I:"'F-r e/'T~A,.e-^~y
<br />. _,..'" ....",,-c-. D ---#o......~ _ ",,,,-,~A'~F ~r ~ ,."r? t!!1F'rLct!"
<br />1le:1''''''..$ _ ~.IC r or S'Y.rr~ .. r_ - , _..--. .. _ #7 "
<br />,,/= e,...t"1 e" <" S Z'!'4 ",c.""
<br />
<br />g. FACILITIES UNDER CONSTRUCTION
<br />h. PRIVATE NON.PROFIT
<br />I. PUBLIC RECREATION
<br />
<br />AA.. cne.<<,e,,~'o/ ~~re~TI..e
<br />
<br />IMPACT:
<br />
<br />" COMPLETE
<br />
<br />COST ESTIMATE
<br />S-
<br />9?oot:J
<br />
<br />SITE CATE. LOCATION (U.. ....1oocIdon,........ dC.)
<br />NO. GO~Y
<br />
<br />,
<br />F"DESCRIPTION OF D_AG,,:
<br />
<br />
<br />IMPACT:
<br />
<br />" COMPLETE
<br />
<br />COST ESTIMATE
<br />
<br />SITE CATE, LOCATION CU....... ro...don,""'" ''''.1
<br />NO. GORY
<br />
<br />DESCRIPTION OF DAMAGE
<br />
<br />IMPACT:
<br />
<br />",COMPLETE
<br />
<br />COST ESTIMATE
<br />
<br />DESCRIPTION OF DAMAGE
<br />
<br />
<br />SITE CATE~ LOCATION W..,..., 'oecatfon..-deIrwa. .Ie.}
<br />NO. GORY
<br />
<br />,
<br />"
<br />,
<br />,
<br />::1
<br />.~.
<br />~~
<br />.'
<br />
<br />IMPACT:
<br />
<br />" COMPLETE
<br />
<br />COST eSTIMATE
<br />
<br />.~~ F INSPECTOR
<br />
<br />AGENCY
<br />
<br />PHONE NO.
<br />OFFICE
<br />
<br />I HOME
<br />
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